Pain and Chronic Kidney Disease
Pain and Chronic Kidney Disease
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DOI：
10.1016/b978-0-12-815876-0.00078-4
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发表时间：
2020-01-01
期刊：
影响因子：
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通讯作者：
Kimmel, Paul L.
中科院分区：
文献类型：
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作者：
Cohen, Scott D.;Davison, Sara N.;Kimmel, Paul L.
几项研究评估了慢性肾脏病（CKD）患者疼痛的有害影响。晚期CKD患者的疼痛患病率估计约为50%-70%。CKD患者疼痛的原因通常与肾脏疾病无关，本质上可分为神经性（由于神经损伤引起的疼痛）或伤害性（由于组织损伤引起的疼痛）。有多种经验证的筛选工具可用于确定患者疼痛的位置、程度和质量，以及任何加剧或缓解因素。这些工具包括但不限于麦吉尔疼痛问卷、埃德蒙顿症状评估系统修订版：肾脏和简明疼痛量表。应进行彻底的评估，以确定患者急性或慢性疼痛综合征的潜在病因。疼痛的管理可以分为非药物和药物的选择。在开慢性疼痛药物之前，应考虑非药物替代品。药物治疗应遵循特定的指南，仔细选择适当的镇痛药，并减少剂量以降低估计的肾小球滤过率，因为最常用的止痛药及其代谢产物经肾脏清除后，CKD不良事件的风险较高。阿片类药物应仅用于其他措施无效的重度疼痛，包括非阿片类药物和辅助镇痛药。可能需要更高的提供者意识和多学科方法，包括评估和管理并发的心理社会问题，以充分解决CKD患者的疼痛。
Several studies evaluate the deleterious impact of pain in patients with chronic kidney disease (CKD). The prevalence of pain has been estimated at approximately 50%-70% in patients with advanced CKD. The causes of pain in CKD patients are often unrelated to the kidney disease and can be categorized as neuropathic (pain due to nerve damage) or nociceptive (pain due to tissue damage) in nature. There are a variety of validated screening tools available to determine the location, degree, and quality of a patient's pain, and any exacerbating or alleviating factors. These tools include, but are not limited to, the McGill Pain Questionnaire, Edmonton Symptom Assessment System-revised:Renal and the Brief Pain Inventory. A thorough evaluation should be undertaken to determine the underlying etiology of a patient's acute or chronic pain syndrome. Management of pain can be divided into nonpharmacologic and pharmacologic options. Non-pharmacologic alternatives should be considered before prescribing chronic pain medications. Pharmacologic treatment should follow specific guidelines with careful selection of appropriate analgesics and dose reduction for reduced estimated glomerular filtration rate, as most commonly used pain medications and their metabolites are renally cleared with a higher risk for adverse events in CKD. Opioids should only be used for severe pain refractory to other measures, including nonopioid and adjuvant analgesics. Greater provider awareness and a multidisciplinary approach including assessment and management of concurrent psychosocial issues are likely required to adequately address pain in CKD patients.